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標題: | 光學追蹤系統於超音波導引肝癌射頻消融治療效果之研究 Therapeutic Outcome with Optical Tracking System in Ultrasound-Guided Radiofrequency Ablation for Hepatocellular Carcinoma |
作者: | 王瑋 Wei Wang |
指導教授: | 黃凱文 Kai-Wen Huang |
關鍵字: | 肝癌,射頻消融,超音波導引,導航系統,光學追蹤系統, hepatocellular carcinoma,radiofrequency ablation,ultrasound-guided,navigation system,optical tracking system, |
出版年 : | 2024 |
學位: | 碩士 |
摘要: | 介紹:
超音波導引射頻消融是一種很值得期待的肝癌治療微創手術。這項手術仰賴即時影像來做探針的導引和監測消融的過程。傳統超音波導引射頻消融依靠徒手操作超音波探頭和探針位置,這可能導致附近重要結構的損傷和不完全消融。為了克服這些挑戰,不同的影像導引導航系統已被研發出來。本研究藉由一個66位病人的臨床試驗,探索一種新的光學追蹤系統用於超音波導引肝癌射頻消融的治療益處。 目的: 使用光學追蹤系統於超音波導引肝癌射頻消融和傳統徒手超音波導引肝癌射頻消融,手術過程和治療效果之比較。 方法: 在這個小病例數前瞻性研究中,我們將患有早期單顆肝癌病人隨機分派至光學追蹤超音波導引射頻消融組及傳統徒手超音波導引射頻消融組。試驗主要終點為腫瘤定位時間及下針準確度(包括針尖偏移及技術成功率)。 試驗次要終點為比較兩組的安全性和併發症發生率。 結果: 試驗總計納入66為肝癌病人。其中36位分派至光學追蹤組,30位分派至傳統徒手(控制)組。光學追蹤組相對於控制組有比較短的腫瘤定位時間(5.55±1.04 min vs 6.22±0.87 min,p 0.007)。光學追蹤組相對於控制組電極比較能放置入腫瘤中心(OR 4.89,95% CI 1.37 to 17.50,p 0.015)。光學追蹤組相對於控制組有比較高的技術成功率 (97.2% vs 80%,p 0.04 on Fisher’s exact test)。光學追蹤組有減低併發症發生率的趨勢(5.6% vs 20%,p 0.08)。光學追蹤組的腫瘤局部復發率較低(2.8% vs 20%,p 0.04 on Fisher’s exact test)。疾病無惡化存活期中位數為12個月。其中光學追蹤組的疾病無惡化存活期中位數為13個月,控制組的疾病無惡化存活期中位數為11個月。光學追蹤組的1年疾病無惡化存活率為66.7%,控制組的1年疾病無惡化存活率為43.3%。兩組的疾病無惡化存活率無差別(HR 0.55,CI 0.25 to 1.23,p 0.144)。 討論: 之前並無有關光學追蹤系統於超音波導引肝癌射頻消融治療定位時間的文獻。在我們的研究中,光學追蹤組定位時間平均減少0.67分鐘。雖然減少的時間並不多,但我們相信光學追蹤系統可能可以幫助肝癌射頻消融的學員或初學者克服學習曲線。將來需要更多的研究來調查光學追蹤系統的使用和學習曲線的關係。 電極偏移與技術成功率(OR 27.33,95% CI 3.43-217.99,p 0.02)和完全消融率(OR 5.37,95% CI 1.29-22.29,p 0.021)高度相關,但與併發症發生率、局部復發率和惡化無關(p>0.05)。 本研究中,技術成功率與較高的完全消融率(OR 43.5,95% CI 3.64-519.25,p 0.003)和較低的併發症發生率(OR 0.12,95% CI 0.21-0.71,p 0.019)高度相關,但與局部復發率和惡化無關(p>0.05)。 光學追蹤組的局部復發率較低。光學追蹤組和控制組有相似的無惡化存活期。然而局部復發和惡化受許多因素影響,並不能單純用是否使用導航系統來解釋。 結論: 超音波導引射頻消融治療的早期單顆肝癌病人,使用NAVIRFA導航系統相較於傳統徒手操作,有較短的手術時間、較準確的探針導引、較低的局部復發率和減少併發症發生率的趨勢。 Introduction: Ultrasound-guided radiofrequency ablation (RFA) is a promising minimally invasive procedure for treating hepatocellular carcinoma (HCC). This procedure relies on real-time imaging to precisely guide the needle and monitor the ablation process. Conventional ultrasound guidance relies on manual manipulation of the probe and needle positioning, which may lead to injury of adjacent critical structures and suboptimal ablation. To overcome these challenges, various image-guided navigation systems have been developed. This study explores the therapeutic benefits of a novel optical tracking system used in ultrasound-guided radiofrequency ablation for hepatocellular carcinoma from a clinical trial with 66 participants. Objectives: To compare the operative procedure and therapeutic outcome of optical tracking ultrasound-guided radiofrequency ablation for hepatocellular carcinoma with those of conventional manual ultrasound-guided RFA. Methods: In this small sample-sized prospective trial, we randomly assigned previously untreated early solitary HCC patients to receive optical tracking ultrasound-guided RFA or conventional manual ultrasound-guided RFA. The primary end points were time for tumor targeting and localization and rate of accurate needle placement (electrode deviation and technique success rate). Secondary end points were to compare the security and complication rate between the two groups. Results: Totally 66 HCC patients were included, of which 36 patients were assigned to optical tracking group, and 30 patients were assigned to conventional (control) group. The optical tracking group exhibited decreased procedure time for tumor targeting and localization compared to the control group (5.55±1.04 min vs 6.22±0.87 min, p 0.007). Optical tracking group also demonstrated more centrally localization of electrode than the control group (OR 4.89, 95% CI 1.37 to 17.50, p 0.015). Technique success rate was higher in optical tracking group (97.2%) than in control group (80%) (p 0.04 on Fisher’s exact test). Optical tracking group had the trend of lower complication rate than control group (5.6% in optical tracking group vs 20% in control group, p 0.08). Local recurrence rate was lower in optical tracking group (2.8%) than in control group (20%) (p 0.04 on Fisher’s exact test). The median follow-up period for progression-free survival was 12 months. The median progression-free survival was 13 months in optical tracking group and 11 months in control group. The 1-year progression-free survival rates were 66.7% in optical tracking group and 43.3% in control group. Progression-free survival had no difference between the two groups (HR 0.55, CI 0.25 to 1.23, p 0.144). Discussion: There was no former literature about targeting time of optical tracking ultrasound-guided RFA for HCC. In our study, mean decrease of targeting time was 0.67 min in optic tracking group. Although the decreased time was not long, we believed that the optical tracking system may help trainee or beginner of RFA for HCC to overcome the learning curve. Further studies may be needed to survey the relationship between use of optical tracking system and learning curve. Electrode deviation was highly correlated with technique success (OR 27.33, 95% CI 3.43-217.99, p 0.02) and complete ablation (OR 5.37, 95% CI 1.29-22.29, p 0.021), but it was not related to complication, local recurrence, and progression (p>0.05). Technique success was highly correlated with higher complete ablation rate (OR 43.5, 95% CI 3.64-519.25, p 0.003) and lower complication rate (OR 0.12, 95% CI 0.21-0.71, p 0.019), but it was not related to local recurrence and progression (p>0.05) in our study. Lower recurrence rate was noted in optical tracking group. Progression-free survival was similar between optical tracking and control group. However, local recurrence and progression are affected by multiple factors, which could not be simply explained by use of navigation system. Conclusions: When performing ultrasound-guided RFA for early solitary HCC, optical tracking system has the advantages of shorter operation time, more accurate needle guidance, lower local recurrence rate and trend of lower complication rate, as compared with conventional manual method. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/91814 |
DOI: | 10.6342/NTU202400363 |
全文授權: | 同意授權(全球公開) |
顯示於系所單位: | 臨床醫學研究所 |
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